Respiratory Failure

Respiratory failure means the lungs cannot keep oxygen in the blood high enough, cannot clear carbon dioxide, or both. It can develop within hours (acute) or over months and years (chronic) as a lung, muscle or chest wall disease advances.

Acute respiratory failure is a medical emergency treated in the nearest hospital, often in intensive care. Chronic respiratory failure is managed over the long term with oxygen, breathing support at night and treatment of the underlying disease.

Symptome

• Breathlessness at rest or on minimal effort
• Fast, shallow breathing and use of neck and shoulder muscles to breathe
• Bluish lips or fingertips
• Morning headaches, daytime sleepiness and poor concentration from retained carbon dioxide
• Confusion, agitation or drowsiness
• Swollen ankles when the right side of the heart is strained
• Disturbed sleep and waking unrefreshed

Ursachen und Risikofaktoren

Low-oxygen (type 1) failure follows conditions that flood or block the air sacs: pneumonia, acute respiratory distress syndrome, pulmonary embolism, fluid from heart failure and advanced lung fibrosis. High-carbon-dioxide (type 2) failure occurs when breathing itself is inadequate: severe COPD, obesity hypoventilation, neuromuscular diseases such as motor neurone disease and muscular dystrophy, severe chest wall deformity, and sedative or opioid overdose. A chest infection often tips a stable chronic condition into an acute crisis.

Wie es diagnostiziert wird

• Pulse oximetry: A quick fingertip estimate of oxygen saturation.
• Arterial blood gas: The defining test. Measures oxygen, carbon dioxide and acidity in blood from the wrist artery.
• Chest X-ray or CT: Looks for pneumonia, fluid, clots, fibrosis or a collapsed lung.
• Lung function and respiratory muscle tests: Used in stable patients to measure the severity of airway and muscle weakness.
• Overnight sleep or carbon dioxide study: Detects under-breathing during sleep, which appears first.
• Echocardiogram: Checks for heart failure and raised lung artery pressure.

Behandlungsmöglichkeiten

• Controlled oxygen: Given to a target saturation. Too much can be harmful in people who retain carbon dioxide.
• Non-invasive ventilation (BiPAP): A mask and machine that support each breath, used in hospital for acute crises and at home at night for chronic failure.
• High-flow nasal oxygen: Warmed, humidified oxygen at high flow for low-oxygen failure.
• Intubation and mechanical ventilation: Intensive care support when other measures fail.
• Treating the cause: Antibiotics, steroids, bronchodilators, diuretics or anticoagulants as appropriate.
• Long-term oxygen therapy: At least 15 hours a day improves survival in COPD with persistently low oxygen.
• Pulmonary rehabilitation and transplant assessment: Exercise programmes for all; lung transplant referral for selected advanced disease.

Wenn es dringend ist

Call emergency services immediately for severe breathlessness, inability to speak in full sentences, blue lips, new confusion or drowsiness, or an oxygen saturation that stays below about 90 per cent (or below your usual level if you have chronic lung disease). These are not situations for travel or for waiting.

Reisen nach Türkiye zur Behandlung

Acute respiratory failure cannot be treated by travelling, and flying is itself a risk: cabin air is equivalent to being at about 2,000 metres, so oxygen levels fall further. People with chronic respiratory failure need a fitness-to-fly assessment and pre-arranged in-flight oxygen. A visit may be reasonable for a stable patient seeking a second opinion, a sleep and ventilation study, or a home ventilator set-up, but the equipment supplier, servicing and follow-up must exist where you live. Long-term care belongs with a local respiratory team.

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